Meal Tax Form - Revenue Division Of Department Of Finance Of Town Of Herndon
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1TOWN OF HERNDON
P.O. BOX 427
HERNDON, VIRGINIA 20172-0427
Business Name:_____________________________________
Address:___________________________________________
MEAL TAX MONTHLY COLLECTION AND REMITTANCE
JANUARY
MAY
SEPTEMBER
FEBRUARY
JUNE
OCTOBER
MARCH
JULY
NOVEMBER
APRIL
AUGUST
DECEMBER
Total Meal Receipts
$
Less Non-Taxable Receipts
$
*Attach explanation for Non-Receipts
Receipts Subject To Meals Tax
$
Meals Tax (1.5% of Receipts)
$
Less 6% For Tax Collection Fee
$
*(On-Time Remittance Fee)
TOTAL DUE
$
TH
BY THE 20
OF THE MONTH
th
10% Penalty (after the 20
of the month)
$
th
10% Interest (after the 30
of the month)
$
TOTAL
$
This report and payment is due on or before the Twentieth day of the month following the Month during which the tax was collected.
Checks should be made payable to the Town of Herndon. Payment received the Twentieth day of the month shall incur a penalty of 10%
of the tax due or ten dollars, whichever is greater. In addition to the penalty, interest of 10% per annum shall be assessed on all delinquent
meal tax payments. Please remit all payments to P.O. Box 427, Herndon, Virginia 20172-0427. If you require additional assistance,
please call (703) 435-6800 ext.2036.
Sign
Print Name
Date
Phone Number
Department of Finance
Revenue Division
777 Lynn Street
Herndon, Virginia 20170-4062
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